Limitation Of External Rotation Research Articles

The value of shoulder distension arthrography with intraarticular injection of steroid and local anaesthetic: a follow-up study.

A series of 51 patients, seen in Leicester, with "frozen shoulder", and referred for arthrographic examination, were assessed both before and after distension arthrography, using air and a low-osmolar contrast media combined with a steroid and local anaesthetic injection. 38 attended for further assessment at up to 6 months later. 16 patients were found to have a rotator cuff tear. There was no significant change in the mean range of active movement in the patients with rotator cuff tears, but symptomatic improvement ensued in 44% of cases. In those found to have no rotator cuff tear, and external rotation of less than 35 degrees, a significant improvement in range of movement was seen. While those with less limitation of external rotation showed no change in their range of movement, they did experience symptomatic improvement in 73% of cases. We conclude that shoulder distension arthrography, with steroid and local anaesthetic injection, may be of symptomatic benefit in patients with frozen shoulder and without a rotator cuff tear, while only those with external rotation of less than 35 degrees are likely to improve their range of motion.

けん板疎部損傷による外傷性肩関節下方脱臼の治療経験

We report a case of traumatic inferior dislocation of the shoulder due to tear of rotator interval and discuss therapeutic approaches.The case was a 16-year-old man who while playing volleyball, jumped at the ball and fell. His left arm was forced into abduction and he noted immediate pain and restriction of shoulder movement.On physical examination, tenderness and swelling were observed along the shoulder, and range of motion was severely limited. Roentgenograms showed inferior dislocation of the left shoulder in the resting position and an arthrogram showed dye projection into the rotator interval.Surgery was performed, with exploration of the rotator interval which was widely opened and the anteroinferior glenoid labrum and middle glenohumeral ligament attached. The coracohumeral ligament was not found. Glenoid labrum and middle glenohumeral ligaments were repaired and rotator interval was closed in the position of internal rotation.The post-operative course was satisfactory and limitation of external rotation did not occur, with the patient able to return to sporting activities.

Arthroscopic shoulder capsulorraphy: does it work?

The purpose of this project was to answer the question, "Can shoulder instability be dealt with safely and effectively arthroscopically?" This study, which began in December 1982 and concluded in February 1985, involved 12 patients, 3 females and 9 males whose ages ranged from 14 to 40 years. Followup ranged from 31 to 63 months, the average being 44.8 months. The arthroscopic procedure was based on the use of a tool designed to capture the capsule, thus allowing placement of either one or two low profile extraarticular staples in the capsule. Two cases were failures. The remaining 10 patients were pleased with their operation. Based on the classification of Rowe et al., functional results were six excellent, two good, two fair, and two poor. The six patients with excellent results had shoulders of normal appearance. They were fully active and had neither pain nor limitation of motion. All six patients had negative apprehension signs. The two patients with good results had similar outcomes, but they had occasional morning stiffness and intermittent mild pain, as well as a 10 degrees limitation of external rotation in both adduction and abduction. One patient who had a fair result had a positive apprehension sign and occasional pain with quick motion. The other patient with a fair result was hampered by more significant pain on an intermittent basis, yet the pain was not a constant issue. None of these patients had radiographic evidence of increased degenerative changes of the shoulder or staple migration. There were two complications and two failures.(ABSTRACT TRUNCATED AT 250 WORDS)

The heel-tip test for restricted tarsal motion.

We describe a simple test that selectively reveals restricted tarsal motion. From functional anatomic data, it is evident that talocalcaneal motion, being essential for intrinsic tarsal mobility, is correlated with rotation of the tibia when tested in a standing person. When supination of the weight-bearing foot generates only a limited external rotation of the tibia, tarsal pathology must be assumed. In 9 feet with a talocalcaneal coalition, axial tibial rotation with the heel-tip test averaged only 8.4 degrees in contrast to an average rotation of 27 degrees in 60 control feet.

A Biomechanical Evaluation of the Lenox Hill Knee Brace

This study was conducted to determine the effectiveness of the Lenox Hill knee brace in limiting anterior translation and external rotation of the tibia in reference to the femur in normal and ligament-deficient knees. Four fresh cadaver knees were fitted with Lenox Hill knee braces according to the manufacturer's guidelines. A computer-assisted testing apparatus was constructed that allowed each knee to be tested as a function of knee flexion angle, joint load, and soft tissue integrity. Each knee served as its own control. While 45 kg of anterior force was applied to the tibia of the anterior cruciate ligament deficient knees, the Lenox Hill knee brace was able to decrease anterior translation from an average of 10 mm, to 5.7 mm, at 30 degrees of flexion when no vertical load was present. This limiting effect was lost when the medial collateral ligament was sectioned in addition to the anterior cruciate ligament or when both the medial and the lateral collateral ligaments were sectioned along with the anterior cruciate ligament. When 20 Newton-meters (Nm) of torque was applied to the femurs at 30 degrees of flexion without vertical load, the Lenox Hill knee brace limited external rotation of the tibia in all tested categories. For intact knees at 30 degrees of flexion and no vertical load, the Lenox Hill knee brace decreased external rotation from 18 degrees to 10 degrees. In the anterior cruciate ligament-sectioned knees, external rotation was decreased from an average of 20.2 degrees to 16.1 degrees. In the knees with sectioned anterior cruciate and medial collateral ligaments, the average reduction was from 21.2 degrees to 15.4 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

The modified staple capsulorrhaphy for the correction of recurrent anterior dislocation of the shoulder

Recurrent anterior dislocation of the shoulder is a fairly common disorder for which numerous surgical procedures have been described. This paper reviews 22 patients treated between 1970 and 1983 by a modified staple capsulorrhaphy. It describes the surgical technique and demonstrates an instrument designed to hold and aid the insertion of the staple. There were no major complications in using this technique. All patients had some restriction of external rotation after operation but no patient suffered a further dislocation during a long-term follow-up of 6.4 years on average.

習慣性肩関節脱臼に対するＢｏｙｔｃｈｅｖ法の経験

Four patients were operated following Boytchev's procedure between 1984-1985.There were 4 males, whose ages ranged from 18 to 39.All cases were affected on one side.One patient had recurrent dislocation after the operation and the mean value of limitation in external rotation was 15 degrees compared with the unaffected side. One patient had a joint mouse in the gleno-humeral joint. We immobilized the affected shoulder for 3 weeks by Desault bandage after the operation.We experienced the temporary musculo-cutaneous nerve paresis in two patients.We could follow up three cases, who had no disturbance in ADL.

Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion.

Rotational subcapital osteotomy of the humerus for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion was performed first by us in 1964 as a trial. From 1967 through 1981, 207 rotational humeral osteotomies were performed. Follow-up was possible on 180 of these shoulders. The over-all redislocation rate was 5.7 per cent and the rate of non-traumatic redislocation, 1.1 per cent. Limitation of motion of more than 10 degrees was present in only 3.9 per cent, the maximum limitation of external rotation being 15 degrees in one patient. The average loss of external rotation was less than 5 degrees, without noticeable diminution of power or function in most patients. The results as graded by a standard rating scale were good to excellent in 90 per cent, fair in 3 per cent, and poor in 7 per cent of the patients. The fair and poor results were due to redislocation, delayed union or non-union, post-traumatic arthritis, and over-rotation at the osteotomy site. Reoperation was necessary in two patients with a non-traumatic recurrence, in six patients with delayed union or non-union, and in one patient with excessive rotation at the osteotomy site. Plate removal was performed one to two years postoperatively in 107 of the 180 shoulders. Of the 321 recurrent dislocations seen over the fourteen-year period, 65 per cent were associated with a moderate to severe posterior-superior impression fracture of the humeral head (Hill-Sachs lesion).(ABSTRACT TRUNCATED AT 250 WORDS)

Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint.

We investigated the stabilizing mechanism of the glenohumeral joint that prevents anterior dislocation by anatomical dissections of the subscapularis, the shoulder capsule, and the superior, middle, and inferior glenohumeral ligaments in thirty-six shoulders of embalmed cadavera. We also performed roentgenographic studies of ten unembalmed cadaver shoulders in which radiopaque markers were used to demonstrate the position, tightness, and laxity of the subscapularis muscle and of the middle and inferior glenohumeral ligaments during external rotation of the shoulder at zero, 45, and 90 degrees of abduction. The subscapularis muscle and the three glenohumeral ligaments were cut in different sequences to determine their relative contributions to stability (limitation of external rotation). The conclusions from these experiments were that at zero degrees of abduction, the subscapularis muscle stabilizes the joint to a large extent; at 45 degrees of abduction, the subscapularis, middle glenohumeral ligament, and anterosuperior fibers of the inferior glenohumeral ligament provide the stability; and as the shoulder approaches 90 degrees of abduction, the inferior glenohumeral ligament prevents dislocation during external rotation.

Treatment of recurrent anterior dislocation and subluxation of the glenohumeral joint in athletes.

This series of 93 Putti-Platt arthroplasties performed on 88 athletes without a recurrence and with the return of each athlete to full participation demonstrates the excellence of this procedure. The 5 year average follow-up further confirms this. Only one valid objection was found. This procedure performed on the dominant shoulder definitely restricts the athlete in throwing a baseball or passing a football, and is not advocated where either of these two functions must be preserved. From this series it was found that operative limitation of external rotation to about

Recurrent Anterior Dislocation of the Shoulder Treated by Putti-Platt Procedure

Six shoulder joints of five cases with recurrent anterior dislocation were treated by the Putti-Platt procedure. The age distribution was ranged from 16 to 24 years. At first, five joints dislocated by trauma and one without trauma. Five joints got no special fixation after primary reduction.On X-ray check in approximately 60° internally rotated position, revealed bony defect of humerus in five joints, and the capsules were found extended more or less in all of them on arthrogram. Detachment and looseness of the capsule and avulsion of the glenoidal labrum were found at surgery.Except one joint had no recurrence of dislocation after surgery and showed slight limitation of external rotation of the shoulder joint. No disabling in daily life was complained.

AN EVALUATION OF THE PUTTI-PLATT RECONSTRUCTION PROCEDURE FOR RECURRENT DISLOCATION OF THE SHOULDER

1. A study of the two-year functional end results of forty-one Putti-Platt reconstruction operations has shown that this procedure is effective in the treatment of recurrent dislocation of the shoulder, regardless of the etiology or the pathological changes. The procedure is available to any qualified surgeon and no special surgical equipment is required. 2. The simplified operation has been as successful as the original technique and has the advantages of decreasing the length of the incision, lessening the amount of tissue trauma, minimizing intra-articular operative damage, and shortening both the duration of the operation and the period of rehabilitation. 3. Shoulders in which original traumatic dislocation has occurred should be completely immobilized for a minimal period of four weeks, regardless of the mechanism of injury, in order to reduce the possibility of recurrence. Dislocations which are spontaneous will probably recur with or without immobilization. 4. Operative correction should be reserved for disabling recurrences in young individuals who are willing to accept the attendant postoperative limitation. 5. Because of the friability of the soft tissues secondary to the trauma of dislocation, operative repair should not be attempted in less that thirty days after any recurrence. 6. Since in all three of our operative failures, the patients had persistent limitation of external rotation, it is suggested that the effectiveness of the procedure is due principally to the resistance given to the anterior thrust of the humeral head by the operative scarring and by the shortened capsular and muscle structures.

RECURRENT DISLOCATION OF THE SHOULDER

A review of the pathology, mechanism, and operative treatment of recurrent dislocation of the shoulder, based on an analysis of 180 cases, with 159 operations, is presented. From this analysis the following conclusions have been made and appear to be substantiated: 1. The pathology comprises two important elements: (a) anterior detachment of the glenoid labrum from the bone margin of the glenoid, associated with some degree of stripping of the anterior part of the capsule from the front of the neck of the scapula, found in 87 per cent. of cases examined adequately at operation; (b) defect or flattening of the posterolateral aspect of the articular surface of the head of the humerus which engages with the glenoid cavity when the arm is in external rotation and abduction; this defect is demonstrated most readily in antero-posterior radiographs taken with the humerus in 60 to 70 degrees of internal rotation and was shown to be present in 82 per cent. of cases which had been subjected to adequate radiographic examination. 2. The frequency of the humeral head defect has been under-estimated in the past, because of the difficulty of demonstrating it, particularly when the defect is small. 3. Either type of lesion alone may predispose to recurrence of the dislocation. 4. Both types of lesion are often present in the same shoulder. When this is the case the tendency to redislocation is great. 5. The initial dislocation, which results in the development of one or both these persistent structural abnormalities, may be due to very different types of injury, the commonest of which is a fall on the outstretched hand. The factor common to all these injuries is a resultant force acting on the humeral head in the direction of the anterior glenoid margin. 6. In the treatment of recurrent dislocation of the shoulder joint the Nicola operation is unreliable, and it may be associated with a recurrence rate as high as 36 per cent. It is believed that continued instability after this operation is usually due to the presence of a defect of the humeral head. 7. Operative treatment should aim at repairing, or nullifying, the effects of both types of lesion. For anterior detachment of the labrum this involves either suturing the labrum back to the glenoid margin, or constructing some form of anterior buttress, fibrous or bony: for humeral head defects it necessitates some procedure designed to limit external rotation, thus preventing the defect from coming into engagement with the glenoid cavity. Such limitation of external rotation does not constitute a significant disability.